Use of antibiotic beads to salvage infected breast implants
Use of antibiotic beads to salvage infected breast implants
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DOI：
10.1016/j.bjps.2017.05.023
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发表时间：
2017-10-01
影响因子：
2.7
通讯作者：
Harmaty, Marco A.
中科院分区：
文献类型：
--
作者：
Sherif, Rami D.;Ingargiola, Michael;Harmaty, Marco A.
目的：当种植体受到感染时，通常会将种植体取出，进行荚膜切除术，并插入新的种植体。患者在PICC线和6-8周静脉注射抗生素后出院。这种方法有不同的成功，并使患者长期全身抗生素。在20世纪60年代，使用抗生素浸渍珠治疗慢性骨髓炎被描述。这些小珠将抗生素直接输送到感染部位，从而消除了全身静脉注射抗生素的并发症。本研究旨在介绍一个病例系列，说明使用含有万古霉素和妥布霉素的刺激硫酸钙微球来增加受感染植入物的抢救率，并放弃静脉注射抗生素。方法：回顾性分析在西奈山医院治疗种植体感染的患者。结果：12例患者确诊，其中10例患有乳腺癌。合并症包括高血压、吸烟和免疫功能低下。术后5天至8年均有感染发生。12个感染种植体中有9个采用抗生素头治疗，不使用家用静脉注射抗生素。结论：应用抗生素微球修复感染假体，无需静脉注射抗生素。75%的植入物被成功回收。在三名植入物无法修复的患者中，一名患者感染了耐抗生素的红球菌，对头部治疗无效，另一名患者不遵守术后指导。(C) 2017年英国整形、重建和美容外科医师协会。Elsevier Ltd.出版。版权所有。
Purpose: When an implant becomes infected, implant salvage is often performed where the implant is removed, capsulectomy is performed, and a new implant is inserted. The patient is discharged with a PICC line and 6-8 weeks of intravenous (IV) antibiotics. This method has variable success and subjects the patient to long-term systemic antibiotics. In the 1960s, the use of antibiotic-impregnated beads for the treatment of chronic osteomyelitis was described. These beads deliver antibiotic directly to the site of the infection, thereby eliminating the complications of systemic IV antibiotics. This study aimed to present a case series illustrating the use of STIMULAN calcium sulfate beads loaded with vancomycin and tobramycin to increase the rate of salvage of the infected implant and forgo IV antibiotics.Methods: A retrospective analysis was performed of patients who were treated at Mount Sinai Hospital for implant infection with salvage and antibiotic beads.Results: Twelve patients were identified, 10 of whom had breast cancer. Comorbidities included hypertension, smoking, and immunocompromised status. Infections were noted anywhere from 5 days to 8 years postoperatively. Salvage was successful in 9 out of the 12 infected implants using antibiotic bead therapy without home IV antibiotics.Conclusions: The use of antibiotic beads is promising for salvaging infected breast implants without IV antibiotics. Seventy-five percent of the implants were successfully salvaged. Of the three patients who had unsalvageable implants, one was infected with antibioticresistant Rhodococcus that was refractory to bead therapy and one was noncompliant with postoperative instructions. (C) 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.